Virtual assistant/chatbot to improve clinical workflows for home renal replacement therapies

ABSTRACT

A virtual assistant/chatbot to improve clinical workflow for home renal replacement therapies is disclosed herein. A virtual assistant/chatbot includes a patient-facing user interface configured to enable a patient to engage in a virtual chat session by typing, speaking, or otherwise providing information regarding a patient request or issue related to their renal replacement therapy. The virtual assistant/chatbot also includes a backend server-based system configured to provide logic to respond to a patient&#39;s requests. The logic defines a sequence of questions and answers for resolving patient queries. The sequence of assistant/chatbot questions and patient answers may be configured in a node arrangement such that certain patient answers/requests lead to additional questions for additional information from a patient. The virtual assistant/chatbot is configured to answer patient requests automatically or determine if the patient request is to be immediately addressed by a clinician or later through a phone call, text, or email communication.

BACKGROUND

Some dialysis therapies (e.g., renal replacement therapies) can beself-administered at home by a patient. The dialysis therapies caninclude automated peritoneal dialysis (“APD”), continuous ambulatoryperitoneal dialysis (“CAPD”), and hemodialysis (“HD”). For theseself-administered therapies, a home nurse typically trains a patient toperform the therapy themselves. The home nurse is also responsible forresponding to patient inquiries and other non-planned interactions thatare outside of regularly scheduled clinic visits. For instance, a newpatient may call the nurse if they have a question related to theadministration of a therapy, such as how to order a certain component(such as dialysis fluid bags or disposable cassettes and transfer sets)or how to react to a certain alarm on a dialysis machine. In addition tothese non-urgent inquiries, in some cases patients may call the nursewith a more urgent issue, such as when they are experiencing acomplication or symptoms of peritonitis. While certain tools exist toanswer many inquiries, such as searchable online databases, the mostcomfortable method for patients, many of whom are elderly, is to use thephone to interact with the nurse. As dialysis therapy takes place daily,a home nurse must be very responsive, even with non-urgent requests, toinsure that these issues and inquiries do not delay a patient's dialysistherapy.

There are two extreme behaviors of dialysis patients with respect totheir interactions with a home nurse. At one extreme, a patient does notwant to bother the nurse even for relatively serious situations. Thesetypes of patients may let an urgent issue, such as peritonitis, go fortoo long prior to escalating the issue with the nurse. This can lead toinfrequent but major complications if issues are not self-identifiedearly. At the other extreme, certain patients call their nurseexcessively, multiple times a week. In these cases, the patients may nothave confidence to perform their therapy and sometimes just wantadditional psychosocial support.

Typically during the day, a nurse is tasked with training new patientsand interacting with patients in a clinic. In some cases, unplannedcalls from home dialysis patients may interrupt the nurse's workflow orscheduled tasks. In other cases, the home nurse may not be available toanswer their phone directly if a home patient calls. Some clinics havean administrative assistant to answer patient inquiry calls, but theseassistants are not medically trained and are not always available. Insmall dialysis clinics, one nurse may also work in other care areas,which means it may be hours to days before they can attend to patientcalls and requests. Most clinics have a nurse's telephone line godirectly to voicemail, such that the nurse responds to these voice mailsafter “regular” office hours.

Unfortunately for schedule planners, nurses spend a significant amountof time responding to unplanned patient interactions. First, theunplanned interactions require time for the nurse to determine anurgency of the interaction. Then, the nurse has to dedicate time tofollow up, even for simple answers to questions or to let a patient knowthey have received their request. The total time responding to unplannedpatient interactions can be up to ten hours/week.

A need accordingly exists for a system that offloads at least some ofthe unplanned interactions with home dialysis patients.

SUMMARY

A virtual assistant/chatbot to improve clinical workflow for home renalreplacement therapies is disclosed herein. The virtual assistant/chatbotincludes a patient-facing user interface that may be provided by adialysis machine or an application (e.g., an App) on a smartphone ortablet. The patient-facing user interface is configured to enable apatient to engage in a virtual chat session by typing, speaking, orotherwise providing information regarding a patient request or issuerelated to their renal replacement or dialysis therapy. The virtualassistant/chatbot also includes a backend server-based system configuredto provide logic to respond to a patient's requests. The logic may bedefined by instructions stored in a memory device or a data structurethat defines a logical sequence of questions and answers for resolvingpatient queries. The sequence of assistant/chatbot questions and patientanswers may be configured in a node arrangement such that certainpatient answers/requests lead to additional assistant/chatbot questionsfor additional information from a patient. However, instead of relyingon answers from a patient for all of the assistant/chatbot questions, atleast some of the assistant/chatbot questions may be determinedautomatically (or at least partially) using medical device data from amedical device (e.g., a dialysis machine) or contained within apatient's electronic medical record.

The logic described herein is configured to categorize, prioritize,and/or escalate a patient's request to better manage a workload ofnurses and other dialysis clinicians. For example, the virtualassistant/chatbot logic described herein is configured to automaticallyrespond to a patient's inquiry or determine whether the patient'sinquiry is to be routed to a primary clinician for more specific-medicalfollow up. The virtual assistant/chatbot logic described herein is alsoconfigured to determine whether a patient's inquiry is to be routed to avoicemail box, virtual message box, email inbox, and/or answeringservice of a nurse (e.g., an at-home nurse) for lower priority issues orinstead connected directly with the nurse for a more urgent medicalemergency. The virtual assistant/chatbot logic described herein is alsoconfigured to determine whether a patient's inquiry is to be routed to amanufacturer of the dialysis machine (or other medical device) toresolve technical issues, reoccurring alarms, or reorder dialysisconsumables such as dialysis fluid bags.

The example virtual assistant/chatbot logic is configured to reducepersonal interactions between patients and nurses for relatively simpleissues. Additionally, the virtual assistant/chatbot logic is configuredto triage incoming patient interactions to appropriate communicationroutes to ensure only critical emergencies are immediately brought tothe attention of clinicians and nurses. The example virtualassistant/chatbot logic accordingly provides an automated system thatincreases patient engagement with their dialysis treatment, therebyproviding better clinical outcomes.

Patients that do not want to bother nurses may use the virtualassistant/chatbot more than their prior interactions knowing they arenot being a disruption. While a nurse or clinician may periodicallyinteract with these patients as needed, the virtual assistant/chatbotlogic identifies more urgent requests, enabling nurses to schedule lessurgent discussions for a time that fits within their schedule and isconvenient to the patient. The virtual assistant/chatbot logicaccordingly helps improve patient compliance with dialysis treatmentswhile improving the chances that more severe medical conditions, such asperitonitis or catheter displacement are resolved sooner.

Additionally, for patients that initiate more request interactions, thevirtual assistant/chatbot logic provides a screen to ensure the specificpatient inquiry is routed to the most appropriate information source orcommunication medium. This configuration ensures one patient does notdisrupt a nurse's schedule on a daily basis but instead only triggers anurse's attention for more serious issues. Further, as these patientsmay expect more personal interaction, the virtual assistant/chatbotacquires sufficient information during initial patient communications toenable a nurse or other clinician to respond as appropriate with theneeded information.

Overall, the virtual assistant/chatbot logic described herein may reduceclinician disruptions by as much as 80%. While clinicians may still haveto respond to 50%-75% of patient inquiries, these inquiries are queuedin a communication system that enables a clinician to respond as theirschedule or workflow permits. Over the course of a year, the examplevirtual assistant/chatbot logic may save a clinician over 200 hours inhandling non-critical disruptions.

The example virtual assistant/chatbot logic and methodology of thepresent disclosure is applicable, for example, to fluid delivery forplasmapherisis, hemodialysis (“HD”), hemofiltration (“HF”)hemodiafiltration (“HDF”), and continuous renal replacement therapy(“CRRT”) treatments. The medical fluid data transfer system describedherein is also applicable to peritoneal dialysis (“PD”), intravenousdrug delivery, and nutritional fluid delivery. These modalities may bereferred to herein collectively or generally individually as a medicalfluid delivery or treatment.

The above modalities may be provided by a medical fluid delivery machinethat houses components needed to deliver medical fluid, such as one ormore pumps, valves, heaters (if needed), online medical fluid generationequipment (if needed), sensors, such as any one, or more, or all ofpressure sensors, conductivity sensors, temperature sensors, airdetectors, blood leak detectors, and the like, user interfaces, andcontrol units, which may employ one or more processors and memory tocontrol the above-described equipment. The medical fluid deliverymachine may also include one or more filters, such as a dialyzer orhemofilter for cleansing blood and/or an ultrafilter for purifyingwater, dialysis fluid, or other fluid.

The medical fluid delivery machine and the medical fluid data transfersystem and methodology described herein may be used with home-basedmachines. For example, the systems may be used with home HD, HF or HDFmachines, which are operated at the patient's convenience. One such homesystem is described in U.S. Pat. No. 8,029,454 (“the '454 Patent”),issued Oct. 4, 2011, entitled “High Convection HomeHemodialysis/Hemofiltration And Sorbent System”, filed Nov. 4, 2004,assigned to the assignees of the present application. Other such homesystems are described in U.S. Pat. No. 8,393,690 (“the '690 Patent”),issued Mar. 12, 2013, entitled “Enclosure for a Portable HemodialysisSystem”, filed Aug. 27, 2008. The entire contents of each of the abovereferences are incorporated herein by reference and relied upon.

As described in detail below, the example virtual assistant/chatbotlogic and methodology of the present disclosure may operate within anencompassing platform or system that may include many machinescomprising many different types of devices, patients, clinicians,doctors, service personnel, electronic medical records (“EMR”)databases, a website, a resource planning system handling data generatedvia the patient and clinician communications, and business intelligence.The example virtual assistant/chatbot logic and methodology of thepresent disclosure operates seamlessly within the overall system andwithout contravening its rules and protocols.

In light of the disclosure herein and without limiting the disclosure inany way, in a first aspect of the present disclosure, which may becombined with any other aspect listed herein unless specified otherwise,a virtual assistant/chatbot system to improve clinical workflows forhome renal replacement therapies includes an interface communicativelycoupled to a network. The interface is configured to communicate with anapplication on user devices or an interface for medical devices. Thesystem also includes a memory device storing a patient inquiry triagedata structure for a virtual assistant or chatbot. The data structureincludes a plurality of potential issues related to dialysis oroperation of a medical device, each issue including a hierarchy ofquestions and possible answers that lead to a response action. Theresponse action includes a direct communication connection with aclinician and a communication connection with a voicemail system, aperson-to-person chat system, or an email system. The system furtherincludes a processor communicatively coupled to the interface and thememory device. The processor is configured to receive an inquiry messagefrom the application on a user device or the interface of a medicaldevice and provide an interactive session using the virtual assistant orchatbot to progress through the hierarchy of questions with one or moreprompts to receive further information until a response action isidentified. When the response action is related to direct communication,the processor is configured to determine an address or number of aclinician device and cause a communication session to be initiatedbetween the application on the user device or the interface of themedical device and the clinician device. When the response action isrelated to the voicemail system, the person-to-person chat system, orthe email system, the processor is configured to determine an account ofa clinician and enable the patient to use the application on the userdevice or the interface of the medical device to enter a request messagefor a clinician.

In accordance with a second aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the processor is further configured to incorporate at leastsome of the further information from the interactive session with therequest message for the clinician.

In accordance with a third aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the processor, the memory device, and the interface arelocated in a cloud-computing environment.

In accordance with a fourth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the inquiry message and the further information is receivedas speech, and the processor is configured to convert the speech totext.

In accordance with a fifth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the processor is further configured to receive a clinicianresponse message from the account of the clinician for the voicemailsystem, the person-to-person chat system, or the email system, andtransmit the clinician response message to the application on the userdevice or the interface of the medical device.

In accordance with a sixth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the response action further includes an automated responseaction, and when the response action is related to the automatedresponse action, the processor is configured to transmit informationindicative of the automated response action to the application on theuser device or the interface of the medical device.

In accordance with a seventh aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the automated response action includes at least one of ananswer from a patient guide, an answer about an order for a medicaldevice consumable item, an answer related to an operation of the medicaldevice, or a preprogrammed answer related to general patient health ormedical conditions.

In accordance with an eighth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the response action further includes a medical devicemanufacturer response action, and when the response action is related tothe medical device manufacturer response action, the processor isconfigured to determine an address or number of a manufacturer deviceand cause a communication session to be initiated between theapplication on the user device or the interface of the medical deviceand the manufacturer device.

In accordance with a ninth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the medical device manufacturer response action relates to atleast one of reordering consumables for the medical device, a technicalissue with the medical device, or an operational issue with the medicaldevice.

In accordance with a tenth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the medical device includes at least one of a peritonealdialysis machine, a hemodialysis machine, a continuous renal replacementtherapy (“CRRT”) machine, an infusion pump, or a patient-controlledanalgesia (“PCA”) machine.

In accordance with an eleventh aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, the processor is further configured to access at leastone of treatment data from the medical device or patient data related tothe patient from an electronic medical record after receiving theinquiry message, and use at least some of the treatment data or thepatient data as answers for progressing through the hierarchy ofquestions as part of the interactive session.

In accordance with a twelfth aspect of the present disclosure, which maybe used in combination with any other aspect listed herein unless statedotherwise, the processor is further configured to access at least one oftreatment data from the medical device or patient data related to thepatient from an electronic medical record after receiving the inquirymessage, and include at least some of the treatment data or the patientdata with the request message for the clinician.

In accordance with a thirteenth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, the treatment data includes at least one of (i)treatment parameters for a dialysis prescription, (ii) results fromperforming one or more dialysis treatments, (iii) diagnostic informationrelated to the medical device, or (iv) a current status of the medicaldevice, and the patient data includes at least one of electronic medicalrecord information, laboratory results, electronic clinician notes,previous medical diagnoses, patient physiological data, or patientdemographic data.

In accordance with a fourteenth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, a hierarchy of the patient inquiry triage datastructure is configured to be modified based on protocols of a hospitalsystem or clinic.

In accordance with a fifteenth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, a virtual assistant/chatbot method to improve clinicalworkflows for home renal replacement therapies includes receiving, in aprocessor, an inquiry message from an application on a user device or aninterface of a medical device and providing , via the processor, aninteractive session using a virtual assistant or chatbot to progressthrough a hierarchy of questions with one or more prompts to receivefurther information until a response action is identified, instructionsfor the virtual assistant or chatbot being stored in a memory devicethat also stores a patient inquiry triage data structure for the virtualassistant or chatbot The data structure includes a plurality ofpotential issues related to dialysis or operation of a medical device,each issue including the hierarchy of questions and possible answersthat lead to a response action. The response action includes a directcommunication connection with a clinician and a communication connectionwith a voicemail system, a person-to-person chat system, or an emailsystem. The method also includes when the response action is related todirect communication, determining, via the processor, an address ornumber of a clinician device and causing a communication session to beinitiated between the application on the user device or the interface ofthe medical device and the clinician device. The method further includeswhen the response action is related to the voicemail system, theperson-to-person chat system, or the email system, determining anaccount of a clinician and enabling the patient to use the applicationon the user device or the interface of the medical device to enter arequest message for a clinician.

In accordance with a sixteenth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, the method further includes incorporating, via theprocessor, at least some of the further information from the interactivesession with the request message for the clinician.

In accordance with a seventeenth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, the inquiry message and the further information isreceived as speech, and the method includes converting the speech totext.

In accordance with an eighteenth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, the method further includes receiving, in theprocessor, a clinician response message from the account of theclinician for the voicemail system, the person-to-person chat system, orthe email system, and transmitting, via the processor, the clinicianresponse message to the application on the user device or the interfaceof the medical device.

In accordance with a nineteenth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, the response action further includes an automatedresponse action, and when the response action is related to theautomated response action, the method further includes transmittinginformation indicative of the automated response action to theapplication on the user device or the interface of the medical device.

In accordance with a twentieth aspect of the present disclosure, whichmay be used in combination with any other aspect listed herein unlessstated otherwise, the automated response action includes at least one ofan answer from a patient guide, an answer about an order for a medicaldevice consumable item, an answer related to an operation of the medicaldevice, or a preprogrammed answer related to general patient health ormedical conditions.

In accordance with a twenty-first aspect of the present disclosure,which may be used in combination with any other aspect listed hereinunless stated otherwise, the method further includes accessing, via theprocessor, at least one of treatment data from the medical device, aprescribed therapy or program, or patient related to the patient from anelectronic medical record after receiving the inquiry message, andincluding, via the processor at least some of the medical device data,the prescribed therapy or program, or the medical information with therequest message for the clinician, wherein the prescribed therapy orprogram includes treatment parameters for a dialysis prescription,treatment data includes at least one of (i) results from performing oneor more dialysis treatments, (ii) diagnostic information related to themedical device, or (iii) a current status of the medical device, andwherein the patient data includes at least one of electronic medicalrecord information, laboratory results, electronic clinician notes,previous medical diagnoses, patient physiological data, or patientdemographic data.

In a twenty-second aspect of the present disclosure, any of thestructure, functionality, and alternatives disclosed in connection withany one or more of FIGS. 1 to 6 may be combined with any otherstructure, functionality, and alternatives disclosed in connection withany other one or more of FIGS. 1 to 6 .

In light of the present disclosure and the above aspects, it istherefore an advantage of the present disclosure to a system that usesvirtual assistant/chatbot logic to automatically triage patientmedical-related requests.

It is another advantage of the present disclosure to use informationprovided by a patient during an interactive session with virtualassistant/chatbot logic to determine if their inquiry is less urgent,semi-urgent, or critically urgent and provide an appropriate responseaction based on the level of urgency.

It is a further advantage of the present disclosure to use patient dataand/or treatment data to more quickly converge upon a response actionfor a patient inquiry.

It is still a further advantage of the present disclosure to use patientdata and/or treatment data as part of content for a response action fora patient inquiry.

Additional features and advantages are described in, and will beapparent from, the following Detailed Description and the Figures. Thefeatures and advantages described herein are not all-inclusive and, inparticular, many additional features and advantages will be apparent toone of ordinary skill in the art in view of the figures and description.Also, any particular embodiment does not have to have all of theadvantages listed herein and it is expressly contemplated to claimindividual advantageous embodiments separately. Moreover, it should benoted that the language used in the specification has been selectedprincipally for readability and instructional purposes, and not to limitthe scope of the inventive subject matter.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a schematic view illustrating a medical system that includesat least one medical fluid delivery machine, according to an embodimentof the present disclosure.

FIG. 2 is a schematic illustration of the medical system of FIG. 1including a clinician server, according to an embodiment of the presentdisclosure.

FIG. 3 shows a diagram of the clinician server, according to an exampleembodiment of the present disclosure.

FIG. 4 is a diagram of a process performed by virtual assistant/chatbotlogic for triaging a patient inquiry, according to an example embodimentof the present disclosure.

FIG. 5 is a diagram that shows an interface of an application providedon a personal mobile communication device, according to an exampleembodiment of the present disclosure.

FIG. 6 is a diagram of a dashboard provided by a clinician applicationfor responding to response actions, according to an example embodimentof the present disclosure.

DETAILED DESCRIPTION

A virtual assistant/chatbot to improve clinical workflow for home renalreplacement therapies is disclosed herein. The virtual assistant/chatbotis configured to provide automated triage of incoming patient requeststo determine when a response can be provided in an automated manner andwhen a response is needed from a clinician or manufacturer of a medicaldevice. The virtual assistant/chatbot ensures that patient requests arequickly attended to while reducing the personal burden of clinicalstaff. The virtual assistant/chatbot is configured to accordinglyimprove patient engagement and treatment compliance by ensuring thatpatient requests are handled in the most efficient and timely mannerpossible.

As discussed herein, the virtual assistant/chatbot includes apatient-facing user interface that may be provided by a dialysis machineor an application (e.g., an App) on a smartphone or tablet. Thepatient-facing user interface is configured to enable a patient toengage in a virtual chat session by typing, speaking, or otherwiseproviding information regarding a question or issue related to theirrenal replacement or dialysis therapy. The virtual assistant/chatbotalso includes a backend server-based system configured to provide logicto respond to a patient's requests. The logic may be defined byinstructions stored in a memory device or a data structure that definesa logical sequence of questions and answers for resolving patientqueries.

Reference is made herein to prescribed therapies or programs andcorresponding treatments. A prescribed therapy or program corresponds toone or more parameters that define how a medical fluid delivery machineis to operate to administer a treatment to a patient. For a peritonealdialysis therapy, the parameters may specify an amount (or rate) offresh dialysis fluid to be pumped into a peritoneal cavity of a patient,an amount of time the fluid is to remain in the patient's peritonealcavity (i.e., a dwell time), and an amount (or rate) of used dialysisfluid and ultrafiltration (“UF”) that is to be pumped or drained fromthe patient after the dwell period expires. For a treatment withmultiple cycles, the parameters may specify the fill, dwell, and drainamounts for each cycle and the total number of cycles to be performedduring the course of a treatment (where one treatment is provided perday or separate treatments are provided during the daytime and duringnighttime). In addition, the parameters (or device programs) may specifydates/times/days (e.g., a schedule) in which treatments are to beadministered by the medical fluid delivery machine. Further, parametersof a prescribed therapy may specify a total volume of dialysis fluid tobe administered for each treatment in addition to a concentration levelof the dialysis fluid, such as a dextrose level.

While a prescribed therapy may specify parameters for each treatmentprovided by a medical fluid delivery machine, the treatment datareported by the machine may differ. As discussed herein, treatment datarefers to data generated by a medical fluid delivery machine that isindicative of measured, detected, or determined parameter values. Forexample, while a prescribed therapy may specify that a treatment is tocomprise five separate cycles, each with a 45-minute dwell time, amedical fluid delivery machine may administer a treatment where fewercycles are provided, each with a 30-minute dwell time. The differencefrom the prescribed parameters may be due to a patient overriding thetherapy program or stopping a treatment prematurely. The medical fluiddelivery machine monitors how the treatment is administered andaccordingly provides parameters that are indicative of the operation.The parameters for the treatment data may include, for example, a totalamount of dialysis fluid administered to a patient, a number of cyclesoperated, a fill amount per cycle, a dwell time per cycle, a draintime/amount per cycle, an estimated amount of UF removed, a treatmentstart time/date, and/or a treatment end time/date. The treatment datamay also include calculated parameters, such as a fill rate and a drainrate, determined by dividing the amount of fluid pumped by the timespent pumping. The treatment data may further include an identificationof an alarm that occurred during a treatment, a duration of the alarm, atime of the alarm, an event associated with the alarm, and/or anindication as to whether the issue that caused the alarm was resolved orwhether the alarm was silenced. The treatment data may also includeevent data, such as times/durations that a medical fluid deliverymachine was stopped/paused or a time when a treatment ended.

In addition to treatment data, the medical fluid delivery system may usepatient data. As disclosed herein, patient data corresponds to medicaldata that may be contained within an electronic medical record (“EMR”),such as medical history, prescription history, current/past treatments,laboratory results, etc. Additionally or alternatively, the patient datamay include demographic data that may be provided by aclinician/patient, specified within a prescribed therapy or program,and/or provided via patient registration. The demographic data mayinclude a patient age, a gender, a patient mobility level, a patient'srenal condition, a prescription history, etc. In some embodiments, thepatient data may include an identifier, which enables the medical fluiddelivery system to store the received data in an appropriate patientrecord located in a database. The identifier may include a patientidentifier, a patient name, and/or an identifier of the medical fluiddelivery system.

As discussed herein, the medical fluid delivery machine is located in aresidence of a patient. However, in some embodiments, the medical fluiddelivery machine may be located at a full-service medical facilityand/or a self-service medical facility. In some embodiments, a patientmay use a first medical fluid delivery machine that is located at theirresidence and use a second medical fluid delivery machine that islocated at a self-service medical facility. In these embodiments, themedical fluid delivery system is configured to combine the treatmentdata from the first and second medical fluid delivery machines.

As disclosed herein, the virtual assistant/chatbot logic is configuredto use one or more computational structures specified in a datastructure that define an interaction with a patient based on one or morepatient answers. It should be appreciated that virtually any datastructure may be used. For example, questions, answers, and results maybe stored as nodes and links in a graph database structure. In anotherexample, questions, answers, and results may be stored in a relational,sequential, or hierarchical data structure. The linkages between answersand questions is configured to guide the virtual assistant/chatbot logicto select which subsequent action is to be performed.

The use of readily available prescribed therapies, treatment data,and/or patient data enables the virtual assistant/chatbot logicdisclosed herein to more accurately and quickly identify a responseaction while reducing answers needed from a patient. In some instances,patient requests or questions that may initially have low context orseem unclear are more readily apparent by the virtual assistant/chatbotlogic analyzing the prescribed therapies, treatment data, and/or patientdata in conjunction with the request. In an example, a patient may startan interaction with the virtual assistant/chatbot logic disclosed hereinby stating that they “Are Tired of this Alarm”. By itself, thisstatement is unclear and could refer to pressure alarms, occlusionalarms, low fluid flow alarms, low battery alarms, etc. However, whenthe virtual assistant/chatbot logic receives such a statement inconjunction with treatment data from the medical fluid delivery machinethat identifies which alarms have recently been triggered, there is ahigh probability that the patient is referring to these recentlytriggered alarms. The example virtual assistant/chatbot logicaccordingly uses available data to quickly converge upon an appropriateresponse action without burdening a patient with excess questions andwithout burdening clinical staff by having to respond to every patientinquiry.

I. Medical Fluid Delivery System Embodiment

The example medical fluid delivery system disclosed herein includes oneor more medical fluid delivery machines. One example of a medical fluiddelivery machine is a renal failure therapy machine. Regarding renalfailure therapy machines, due to various causes, a patient's renalsystem can fail. Renal failure produces several physiologicalderangements. For instance, a patient experiencing renal failure can nolonger balance water and minerals or excrete daily metabolic load. Toxicend products of nitrogen metabolism (urea, creatinine, uric acid, andothers) can accumulate in the patient's blood and tissue.

Kidney failure and reduced kidney function have been treated withdialysis. Dialysis removes waste, toxins and excess water from the bodythat normal functioning kidneys would otherwise remove. Dialysistreatment for replacement of kidney functions is critical to many peoplebecause the treatment is life saving.

One type of kidney failure therapy is Hemodialysis (“HD”), which ingeneral uses diffusion to remove waste products from a patient's blood.A diffusive gradient occurs across a semi-permeable dialyzer between apatient's blood and an electrolyte solution, called dialysate ordialysis fluid, to cause diffusion.

Hemofiltration (“HF”) is an alternative renal replacement therapy thatrelies on a convective transport of toxins from the patient's blood. HFis accomplished by adding substitution or replacement fluid to theextracorporeal circuit during treatment (typically ten to ninety litersof such fluid). The substitution fluid and the fluid accumulated by thepatient in between treatments is ultrafiltered over the course of the HFtreatment, providing a convective transport mechanism that isparticularly beneficial in removing middle and large molecules (inhemodialysis there is a small amount of waste removed along with thefluid gained between dialysis sessions, however, the solute drag fromthe removal of that ultrafiltrate is not enough to provide convectiveclearance).

Hemodiafiltration (“HDF”) is a treatment modality that combinesconvective and diffusive clearances. HDF uses dialysis fluid flowingthrough a dialyzer, similar to standard hemodialysis, to providediffusive clearance. In addition, substitution solution is provideddirectly to the extracorporeal circuit, providing convective clearance.

Most HD (HF, HDF) treatments occur in centers. A trend towards homehemodialysis (“HHD”) exists today in part because HEM can be performeddaily, offering therapeutic benefits over in-center hemodialysistreatments, which occur typically bi- or tri-weekly. Studies have shownthat frequent treatments remove more toxins and waste products than apatient receiving less frequent, but perhaps longer treatments. Apatient receiving treatments more frequently does not experience as muchof a down cycle compared to an in-center patient, who has built-up twoor three days' worth of toxins prior to treatment. In certain areas, theclosest dialysis center can be many miles from the patient's homecausing door-to-door treatment time to consume a large portion of theday. HHD in contrast may take place overnight or during the day whilethe patient relaxes, works or is otherwise productive.

Another type of kidney failure therapy is peritoneal dialysis, whichinfuses a dialysis solution, also called dialysis fluid, into apatient's peritoneal cavity via a catheter. The dialysis fluid contactsthe peritoneal membrane of the peritoneal cavity. Waste, toxins andexcess water pass from the patient's bloodstream, through the peritonealmembrane and into the dialysis fluid due to diffusion and osmosis, i.e.,an osmotic gradient occurs across the membrane. An osmotic agent indialysis provides the osmotic gradient. The used or spent dialysis fluidis drained from the patient, removing waste, toxins and excess waterfrom the patient. This cycle is repeated, e.g., multiple times.

There are various types of peritoneal dialysis therapies, includingcontinuous ambulatory peritoneal dialysis (“CAPD”), automated peritonealdialysis (“APD”), and tidal flow dialysis and continuous flow peritonealdialysis (“CFPD”). CAPD is a manual dialysis treatment. Here, thepatient manually connects an implanted catheter to a drain to enableused or spent dialysate fluid to drain from the patient's peritonealcavity. The patient then connects the catheter to a bag of freshdialysis fluid to infuse fresh dialysis fluid through the catheter andinto the patient. The patient disconnects the catheter from the freshdialysis fluid bag and enables the dialysis fluid to dwell within theperitoneal cavity, where the transfer of waste, toxins, and excess watertakes place. After a dwell period, the patient repeats the manualdialysis procedure, for example, four times per day, each treatmentlasting between an hour and six hours. Manual peritoneal dialysisrequires a significant amount of time and effort from the patient,leaving ample room for improvement.

Automated peritoneal dialysis (“APD”) is similar to CAPD in that thedialysis treatment includes drain, fill and dwell cycles. APD machines,however, perform the cycles automatically, typically while the patientsleeps. APD machines free patients from having to perform the treatmentcycles manually and from having to transport supplies during the day.APD machines connect fluidly to an implanted catheter, to a source orbag of fresh dialysis fluid and to a fluid drain. APD machines pumpfresh dialysis fluid from a dialysis fluid source, through the catheterand into the patient's peritoneal cavity. APD machines also allow forthe dialysis fluid to dwell within the cavity and for the transfer ofwaste, toxins, and excess water to take place. The source may includemultiple sterile dialysis fluid bags.

APD machines pump used or spent dialysate from a patient's peritonealcavity, though a catheter, and to a drain. As with the manual process,several drain, fill and dwell cycles occur during dialysis. A “lastfill” occurs at the end of APD and remains in the peritoneal cavity ofthe patient until the next treatment.

Any of the above modalities performed by a machine may be run on ascheduled basis and may require a start-up procedure. For example,dialysis patients typically perform treatment on a scheduled basisspecified by a prescribed therapy or program, such as every other day,daily, etc. Blood treatment machines typically require a certain amountof time before treatment for setup, for example, to run a disinfectionprocedure. Patients for the above modalities may lead busy lives andhave projects to perform or errands to run on a day scheduled fortreatment.

Much of the appeal of a home treatment for the patient revolves aroundthe lifestyle flexibility provided by allowing a patient to performtreatment in his or her home largely according to his or her ownschedule. The home medical fluid delivery machine may, however, includesoftware timers that dictate to and constrain the patient. A homehemodialysis system may, for example, require a patient to be inimmediate proximity to the home hemodialysis machine to initiatepre-treatment, during treatment, and post-treatment sequences.

In one particular example, a therapy machine may reuse certaincomponents by disinfecting them in between treatments. The machine mayemploy one or more disinfection timers that require a patient orcaregiver to start a treatment using the machine before the disinfectiontimer expires. Otherwise, the patient will have to wait until anotherdisinfection procedure is completed before starting treatment. Thetherapy machine in an embodiment communicates the treatment start timedeadlines via the machine's graphical user interface.

It is contemplated for the software of the system and methodology of thepresent disclosure to disable communication between the patient and/orcaregiver and the machine whenever the machine is in a “patientconnected” software state. For example, if a clinician tries to send acommand to a machine currently treating a patient, the command may beintercepted by a middleware software application so that the command isnot transferred to the machine. The middleware software application maythen communicate back to the clinician informing that the machine isbusy and not accepting communication.

The examples described herein are applicable to any medical fluiddelivery system that delivers a medical fluid, such as blood, dialysisfluid, substitution fluid or and intravenous drug (“IV”). The examplesare particularly well suited for kidney failure therapies, such as allforms of hemodialysis (“HD”), hemofiltration (“HF”), hemodiafiltration(“HDF”), continuous renal replacement therapies (“CRRT”) and peritonealdialysis (“PD”), referred to herein collectively or generallyindividually as a prescribed therapy or program. The medical fluiddelivery machines may alternatively be a drug delivery or nutritionalfluid delivery device, such as a large volume peristaltic type pump or asyringe pump. The machines described herein may be used in homesettings. For example, a machine operating with a data transfercomponent may be employed with a home HD machine, which can, forexample, be run at night while the patient is sleeping. The medicalfluid data transfer system and methodology of the present disclosure mayalternatively be used to help clinicians or nurses in hospitals and/orclinics.

Referring now to the drawings, and in particular to FIG. 1 , a medicalsystem 10 is illustrated. The example system 10 includes many medicalfluid delivery machines 90 (one type of which is discussed in detailbelow). The machines 90 of the medical system 10 may be of a same type(e.g., all PD machines) or be of different types (e.g., a mix of HD, PD,CRRT, and medical or nutritional fluid delivery).

While a single medical fluid delivery 90 is illustrated as communicatingwith a connectivity server 118, the system 10 manages the operation of aplurality of medical fluid delivery systems and machines, of the sametype or of different types listed above. For example, there may be Mnumber of hemodialysis machines 90, N number of hemofiltration machines90, O number of CRRT machines 90, P number of peritoneal dialysismachines 90, Q number of home drug delivery machines 90, and R number ofnutritional or drug delivery machines 90 connected to the server 118 andoperating with the system 10. The numbers M through R may be the same ordifferent numbers, and may be zero, one, or more than one. In FIG. 1 ,the medical fluid delivery machine 90 is illustrated as a therapymachine 90 (the home indicated by dashed lines).

The therapy machine 90 may receive at its front end purified water froma water treatment device 60. The water treatment device 60 connects tothe therapy machine 90 via an Ethernet cable, in an embodiment. Thetherapy machines 90 in the illustrated embodiment operates with otherdevices besides the water treatment device 60, such as a blood pressuremonitor 104, a weigh scale, e.g., a wireless weigh scale 106, and a userinterface such as a wireless tablet user interface 122. The therapymachine 90 connects to the server 118 wirelessly in one embodiment via amodem 102. Each of these components may (but does not have to be)located within the patient's home, as demarcated by the dashed lines inFIG. 1 . Any one, or more, or all of the components 60, 104, 106 and 122may communicate wired or wirelessly with the therapy machine 90.Wireless communication may be via Bluetooth™, WiFi™, Zigbee®, Z-Wave®,wireless Universal Serial Bus (“USB”), infrared, or any other suitablewireless communication technology. Alternatively, any one, or more orall of the components 60, 104, 106 and 122 may communicate with thetherapy machine 90 via wired communication.

The example connectivity server 118 communicates with the medical fluiddelivery machine 90 via a medical device system hub 120. The examplesystem hub 120 enables data and information concerning each therapymachine 90 and its peripherals to travel back and forth via theconnectivity server 118 between the machines 90 and the other devicesthat are connected to the server 118. In the illustrated embodiment, thesystem hub 120 is connected to a service portal 130, an enterpriseresource planning system 140, a web portal 150, a business intelligenceportal 160, a HIPAA compliant database 124, a product development team128, and electronic medical records databases maintained, for example,at clinics or hospitals 126 a to 126 n. The connectivity server 118and/or the portals 130, 150, and 160 may include gateway devices.

The illustrated electronic medical records (“EMR”) databases may belocated at clinics or hospitals 126 a to 126 n and store electronicinformation concerning patients. The system hub 120 may transmit thedata collected from log files of machine 90 (e.g., treatment data) tothe hospital or clinic databases 126 a to 126 n to merge or supplementthat patient's medical records. The databases at clinics or hospitals126 a to 126 n may contain patient-specific treatment and prescriptiondata (e.g., prescribed therapies or programs), where access to suchdatabases may be highly restricted. The example enterprise resourceplanning system 140 is configured to obtain and compile data generatedvia patient and clinician website access, such as complaints, billinginformation, and life cycle management information. The web portal 150enables patients and clinics 152 a to 152 n treating the patients toaccess a website that is publicly available. The business intelligenceportal 160 collects data from the system hub 120 and provides the datato marketing 162, research and development 164, andquality/pharmacovigilance 166.

It should be appreciated that the systems, methods and proceduresdescribed herein may be implemented using one or more computer programsor components. The programs of the components may be provided as aseries of computer instructions on any computer-readable medium,including random access memory (“RAM”), read only memory (“ROM”), flashmemory, magnetic or optical disks, optical memory, or other storagemedia. The instructions may be configured to be executed by a processor,which when executing the series of computer instructions, performs orfacilitates the performance of all or part of the disclosed methods andprocedures that are described herein.

In one embodiment, the therapy machine 90 performs a home treatment,such as home peritoneal dialysis on a patient at the patient's home ,andthen reports the results of that treatment (as treatment data) to thesystem hub 120, which may be in communication with one or more servers.As described in more detail below, the one or more servers analyze thetreatment data for reporting to clinicians, doctors, and/or nurses whoare responsible for managing the health and well-being of that patient.

The therapy machines 90 in an embodiment writes log files using, e.g., aLinux™ operating system. The log files document pertinent therapymachine 90 data, including peripheral device data. The log files mayinclude any one or more of Extensible Markup Language (“XML”),comma-separated values (“CSV”), or text files. The log files are placedinto a file server repository managed by software of therapy machine 90.It is also contemplated to store data at a peripheral device, e.g.,water treatment device 60, which is not sent to machine 90. Such datamay otherwise be obtained via the wired or wireless connection to theperipheral device or downloaded through other data connections orstorage media.

In one embodiment, the therapy machine 90, e.g., via the internet, usesa connectivity service to transfer treatment data between the modem 102and the system hub 120. Here, a dedicated line may be provided at eachpatient's home for connecting the therapy machine 90 to the connectivityserver 118 via the modem 102. The therapy machine 90, in one embodiment,accesses the internet using a separate, e.g., 3G, 4G, or 5G, modem 102.The modem 102 may use an internet Service Provider (“ISP”), such asVodafone™. In one implementation, a connectivity agent 114 developed bya connectivity service provider (e.g., provider of connectivity server118) is installed onto the therapy machine 90 and run on a primarycontrol processor (“ACPU”) 50 of the machine. One suitable connectivityservice is provided by Axeda™, which provides a secure managedconnection 116 between medical devices and the connectivity server 118.

The example connectivity agent 114 of FIG. 1 is configured to enable thetherapy machine 90 to connect to the connectivity server 118 andtransfer the treatment data to and from the connectivity server 118. Aconnectivity service operating via the agent 114 and the server 118ensures that the connection with the machine 90 is secure, ensures thatthe data correctly passes through the machine 90's firewalls, detectswhether there has been a data or system crash, and ensures that theconnectivity server 118 is communicating with the correct therapymachine 90.

In one embodiment, the therapy machine 90 may only connect to theconnectivity server 118 when the connectivity agent 114 is turned on oractivated. During treatment and post-treatment disinfection, while themachine 90 and its peripherals are functioning, the connectivity agent114 is automatically turned off in one embodiment, which prevents thetherapy machine 90 from communicating with any entity and sending orreceiving data during treatment and disinfection or when machine 90 islive or running. When the therapy machine 90 is idle, e.g., aftertreatment and post-disinfection is complete, the ACPU 50 turns theconnectivity agent 114 on, in one embodiment. In an embodiment, theconnectivity agent 114 is off during treatment, and possiblypre-treatment. After treatment, the connectivity agent 114 retrieves thelog files from the therapy machine 90 and transfers the treatment datato the connectivity server 118 using the connectivity service. Theconnectivity service routes data packets to their proper destination,but in one embodiment, does not modify, access, or encrypt the data.

In medical system 10 system of FIG. 1 , the connectivity service via theconnectivity server 118 may communicate data to various places via thesystem hub 120, such as the service portal 130, the clinics or hospitals126 a to 126 n, and the web portal 150. The connectivity server 118enables service personnel 132 a to 132 n and/or clinicians to track andretrieve various assets across the network, such as appropriate therapymachines 90 and 3G, 4G, or 5G modem 102, and their associatedinformation, including machine or modem serial numbers. The connectivityserver 118 may also be used to receive and provide firmware upgrades,approved by a director of service personnel 134 and obtained remotelyvia the service portal 130, to the authorized therapy machines 90 andassociated peripherals, such as water treatment devices 60.

A. Connectivity Embodiment of the Example Medical Fluid Delivery System

FIG. 2 illustrates a diagram of the medical system 10 of FIG. 1 ,according to an example embodiment of the present disclosure. Theexample medical system 10 includes, for example, a personal mobilecommunication device 122 (e.g., a user device) that is operated by apatient, and a clinician device 152 that is operated by a clinician. Themedical system 10 also includes a therapy machine 90 (e.g., a medicalfluid delivery machine), which is similar to the respective devicesdiscussed above in connection with FIG. 1 . The personal mobilecommunication device 122 and the therapy machine 90 may be located, forexample, at a patient's home, a self-service clinic, and/or a servicedmedical clinic.

The therapy machine 90 may include any type of hemodialysis machine,peritoneal dialysis machine, CRRT machine, drug and/or nutritional fluiddelivery machine, and combinations thereof. The therapy machine 90 mayprovide, for example continuous cycling peritoneal dialysis (“CCPD”),tidal flow automated peritoneal dialysis (“APD”), and continuous flowperitoneal dialysis (“CFPD”). The therapy machine 90 may perform drain,fill, and dwell cycles automatically, typically while a patient sleeps.

The example therapy machine 90 may also include one or more controlinterfaces 201 for displaying instructions and receiving control inputsfrom a user. The control interfaces 201 may include buttons, a controlpanel, and/or a touchscreen. The control interfaces 201 may also beconfigured to enable a user to navigate to a certain window or userinterface on a screen of the therapy machine 90. The control interfaces201 may further provide instructions for operating or controlling thetherapy machine 90.

The example therapy machine 90 may receive one or more prescribedtherapies or programs 202 remotely from a clinician server 204 and/or aclinician database 206. Additionally or alternatively, the therapymachine 90 may be programmed locally via the control interface 201 witha prescribed therapy or program 202. As discussed herein, a prescribedtherapy 202 includes parameters that specify how the therapy machine 90is to administer one or more scheduled treatments to a patient (e.g.,the patient 12 of FIG. 1 ). The therapy parameters 202 may include anumber of fill-dwell-drain cycles for a peritoneal dialysis therapy inaddition to a duration for each phase. The therapy parameters may alsoinclude a total volume of dialysis fluid to be administered (and/or avolume of fluid to be administered per cycle), a dextrose concentration,and/or a target UF removal level. The therapy parameters 202 may alsoinclude a schedule of treatment dates and a total treatment duration. Insome embodiments, the clinician server 204 may remotely update any oneof the prescribed therapy parameters.

It should be appreciated that the medical system 10 may includeadditional medical devices such as a weight scale, a blood pressuremonitor, an infusion pump (e.g., a syringe pump, a linear peristalticpump, a large volume pump (“LVP”), an ambulatory pump, a multi-channelpump), an oxygen sensor, a respiratory monitor, a glucose meter, a bloodpressure monitor, an electrocardiogram (“ECG”) monitor, and/or a heartrate monitor. In other examples, the medical fluid data transfer system90 may include fewer medical devices and/or medical devices integratedwith the therapy machine 90.

As shown in FIG. 2 , the therapy machine 90 is communicatively coupledto the connectivity server 118 via a network 210. As discussed above inconnection with FIG. 1 , the connectivity server 118 providesbidirectional communication between the therapy machine 90 and thesystem hub 120. The network 210 may include any wired or wirelessnetwork including the Internet, a cellular network, or combinationsthereof.

The example system hub 120 is also communicatively coupled to theclinician server 204 and the clinician database 206. As described inmore detail below, the clinician server 204 is configured to execute oneor more instructions, routines, algorithms, applications, or programs(e.g., a virtual assistant/chatbot) 212 for determining how patientrequests are to be handled. The clinician database 204 is configured tostore prescribed therapies or programs 202 for each patient associatedwith the system 10. The clinician database 206 is also configured tostore one or more records for each patient that include treatment data213 from the respective therapy machine 90 and/or patient data 214(e.g., a patient's EMR).

In the illustrated example, the clinician server 204 is communicativelycoupled to a memory device 220 that stores the one or more instructions,routines, algorithms, applications, or programs for executing thevirtual assistant/chatbot logic 212. The memory device 220 may alsostore one or more data structures and/or instructions 222 that define anautomated interaction with a patient to for determining a responseaction 238. The one or more instructions, routines, algorithms,applications, or programs for executing the virtual assistant/chatbotlogic 212 and/or the one or more data structures and/or instructions 222may include machine-readable instructions, that when executed by one ormore processors of the clinician server 204, cause the clinician server204 to perform the operations described herein.

As discussed herein, a response action 238 is an operation carried outby the clinician server 204 based on a level of response needed for apatient inquiry or request. The response action 238 may includedetermining that an automated response is appropriate and transmittingone or more messages to the patient with technical/medical information(as the response action 238) for addressing a low or less-urgentpatient's inquiry. The response action 238 may also include determiningthat the patient's inquiry has a medium urgency and that the inquiryshould be transmitted in one or more messages (as the response action238) to a voicemail system, a person-to-person chat system, or an emailsystem of a clinician. In some embodiments, the clinician server 204determines which clinician is to receive the message based on a nameprovided by the patient, a documented past relationship with the patient(as provided in the patient data 214), or based on a role orresponsibility in relation to the request. After identifying theclinician, the clinician server 204 determines a corresponding accountand transmits the response action 238 to the account. In someembodiments, the clinician server 204 prompts the patient to enter theirquery. Additionally or alternatively, the clinician server 204 usesinformation from an interaction of the patient with the virtualassistant/chatbot 212 to automatically create content for the responseaction 238. In this manner, not only is the data 202, 213, and 214 usedfor navigating the patient interaction, it may be used in conjunctionwith patient responses for conveying specific request information to theclinician.

In an example, a patient may initiate an inquiry by starting through anapplication 140 on their personal mobile communication device 122 thatthey cannot resolve an alarm. In response, the clinician server 204 usesthe virtual assistant/chatbot 212 to determine from the patient whatactions they have already tried to resolve the alarm. Further, theclinician server 204 locates relevant treatment data 213 to determinethe type of alarm and/or recent dates/times the alarm was activated.Based on this collection of data, the clinician server 204 determinesthat the patient inquiry is a medium-level (because intermittent alarmsare annoying but not critical), and accordingly prompts the patient toenter information for the response action 238 and/or uses at least someof the patient responses to the virtual assistant/chatbot 212 and/or thetreatment data 213/patient data 214 for creating content for theresponse action 238, which is provided as a text message, multimediamessage, email message, etc. to an appropriate clinician account that isassociated with resolving alarms. In an example, the response action 238includes a recorded personal inquiry from the patient (possibly withvideo or images of the display interface 201 of the therapy machine 90showing the alarm) in addition to the alarm-based treatment data 213and/or patient data 214 for additional context.

In instances where the clinician server 204 determines that the patientrequest is critical or urgent, the clinician server 204 identifies aclinician and establishes a direct communication link between aclinician device 152 of the identified clinician and the personal mobilecommunication device 122 of the patient. The communication may include avoice call, a video call, and/or an active chat session.

As illustrated in FIG. 2 , the example medical system 10 includes a webportal 150 to facilitate the transmission of data to the cliniciandevice 152 and/or the personal mobile communication device 122 via anetwork 230. The example network 230 may include any wired and/orwireless network, such as the Internet, a cellular network, orcombinations thereof. The networks 210 and 230 may include the samenetwork.

The web portal 150 may include one or more application programminginterfaces (“API”) or other network interfaces that provide for thecommunication of treatment data 213, patient data 214, and/or responseactions 238. The web portal 150 may also establish communicationsessions between the clinician device 152 and the personal mobilecommunication device 122. In some instances, the web portal 150 may beconfigured as a gateway device and/or firewall such that only authorizedusers and/or devices may communicate with the clinician server 204and/or the clinician database 206. Further, the web portal 150 maycreate a separate session for each connected device 122 and 152.

The clinician device 152 and/or the personal mobile communication device122 may include a respective application 240 and 242 that is configuredto interface with the web portal 150 for communicating with theclinician server 204 and/or the clinician database 206. For example, theapplication 240 may include one or more user interfaces with data fieldsthat are configured to receive a patient request or question. Theapplication 240 is also configured to operate with a telephone featureof the personal mobile communication device 122 to enable a voice orvideo call to be routed to the clinician server 204 to interact with thevirtual assistant/chatbot 212. The application 242 may also include orprovide access to an email service, a text message service, or amultimedia message service to enable a patient to enter information forinteracting with the virtual assistant/chatbot 212 and/or cliniciandevice 152.

The application 242 of the clinician device 152 is configured with oneor more interfaces for receiving a response action 238 from theclinician server 204. The interfaces also enable a clinician to providea response to a request or inquiry from the personal mobilecommunication device 122. The application 242 is also configured tooperate with a telephone feature of the clinician device 152 to enable avoice or video call to be received from the personal mobilecommunication device 122. The application 242 may also include orprovide access to an email service, a text message service, or amultimedia message service for viewing and responding to patientinquiries (provided by response actions 238 via the clinician server204).

In other instances, the applications 240 and 242 are web browsersconfigured to access one or more web pages via the web portal 150 thatare hosted or managed by the clinician server 204. In these otherinstances, the clinician server 204 provides the user interfaces andcorresponding data fields in one or more web pages. A user may interactwith the web browser to view or enter desired data. The applications 240and 242 may also include native control or other installed applicationson the devices 122 and 152.

In some instances, the web portal 150 is configured to convertprescribed therapies or programs 202, treatment data 213, and/or patientdata 214 from a text-based standard or Health-Level-7 (“HL7”) standard(e.g., a medical standard) to a web-based message (e.g., a HTTP message,an HyperText Markup Language (“HTML”) message, an Extensible MarkupLanguage (“XML”) message, a JavaScript Object Notation (“JSON”) payload,etc.). In other embodiments, the connectivity server 118 is configuredto convert HL7 prescribed therapies or programs 202, treatment data 213,and/or patient data 214 from the therapy machine 90 into a text-based orweb-based format (e.g., a JSON format) for processing by the clinicianserver 204 and storage by the clinician database 206.

In the illustrated example of FIG. 2 , the example personal mobilecommunication device 122 and the clinician device 152 include aprocessor 250 that is in communication with a memory 252 storinginstructions. At least some of the instructions define or specify therespective application 240 and 242, that when executed by the processor250, cause the processor 250 to provide interfaces for handling patientinquiries using the virtual assistant/chatbot 212. The processor 250 maycomprise digital and/or analog circuity structured as a microprocessor,application specific integrated circuit (“ASIC”), controller, etc. Thememory 252 includes a volatile or non-volatile storage medium. Further,the memory 252 may include any solid state or disk storage medium.

The example medical system 10 of FIG. 2 may also include a third-partyserver 260 that is associated with a manufacturer of the therapy machine90. In some instances, the clinician server 204 determines that apatient inquiry relates to an operation or technical issue with thetherapy machine 90. In these instances, instead of sending a message toa clinician, the clinician server 204 transmits a message with theresponse action 238 to the third-party server 260. The response action238 may include opening a live communication session or providing a textmessage, multimedia message, an email, etc. to a call center or otherdiagnostic center that is related to the third-party server 260.

II. Clinician Server-Virtual Assistant/Chatbot Embodiment

As discussed above, the example clinician server 204 of FIG. 2 isconfigured to provide an interactive session with a patient to triagetheir request. FIG. 3 shows a diagram of the clinician server 204,according to an example embodiment of the present disclosure. In theillustrated example, the clinician server 204 includes instructions orsoftware modules 302 to 320 that specify how the clinician server 204performs certain operations. The instructions 302 to 320 are used by theclinician server 204 to perform operations of the virtualassistant/chatbot logic 212. The blocks shown in FIG. 3 representcertain operations defined by the instructions 302 to 320. In otherembodiments, some of the blocks may be combined, further partitioned, orinclude additional blocks. Further, while the clinician server 204 isshown as centrally located, in other embodiments, the clinician server204 and/or the clinician database 206 may be deployed within a cloudcomputing environment.

The example instructions 302 to 320 include a speech-text conversionmodule 302, which receives audio or voice commands from the personalmobile communication device 122. The speech-text conversion module 302receives digital data and/or analog signals that include recorded humanspeech. The speech-text conversion module 302 is configured to convertthe digital data and/or analog signals to text using one or morespeech-to-text algorithms.

The speech-text conversion module 302 transmits the converted text to alanguage processing module 304, which is configured to use one or morealgorithms to amend the received text based on known or learned accents,speech, or slang of a user. The language processing module 304 mayinclude a library of known accents, speech, and/or slang for differenttypes of users. The language processing module 304 selects appropriatetextual modifiers based on how well a patient matches certain accents,speech, and/or slang. In some instances, the language processing module304 may use one or more machine learning algorithms for identifyingand/or modifying text based on the identified accent, speech, or slangof a user. The language processing module 304 outputs modified text thattakes into account a user's accent, speech, or slang. For instance, thelanguage processing module 304 may receive a textual input from thespeech-text conversion module 302 that includes combinations of vowels,constants, and breaks. After filtering through the language processingmodule 304, the string of vowels, constants, and breaks is modified intotextual words and/or phrases, which are input into a speech recognitionmodule 306.

The speech recognition module 306 is configured to operate one or morenatural language processing algorithms to determine a meaning ofreceived words or phrases. The speech recognition module 306 in someembodiments identifies a meaning of a string of words or phrases, thewith identified meaning being stored as metadata, in separate datafields, or otherwise appended to the words and/or phrases. The speechrecognition module 306 may analyze words or phrases to identify that aquestion is being asked, and a subject of the question. In this example,the speech recognition module 306 appends that the words or phrasescorrespond to a question and keywords that are associated with thequestion. The processing performed by the speech recognition module 306adds formatted information that enables subsequent analysis based onmore defined linguistic parameters.

In some embodiments, the speech recognition module 306 is configured tosearch for certain keywords for starting a virtual session with apatient. If a virtual session is not already in progress, the speechrecognition module 306 listens or otherwise processes text and phrasesfor certain keywords or phrases that are indicative to start a session.For example, the virtual assistant/chatbot may be called “Claria”.Accordingly, the speech recognition module 306 searches for the term“Claria” or similar spellings. If a match is made, the speechrecognition module 306 begins a virtual session with a patient andprocesses the phrase that includes the “Claria” term. At this point, thespeech recognition module 306 processes subsequent words and/or phrasesas part of the virtual conversation. However, if a match is not made,the speech recognition module 306 discards the text from furtherprocessing so as to refrain from recording other patient conversationsor ambient room sounds. It should be appreciated that the virtualassistant/chatbot 212 may also be activated by a patient by selecting acorresponding icon that is displayed by the user interface 201 of thetherapy machine 90 or the application 240 of the personal mobilecommunication device 122.

The example clinician server 204 also includes a response engine 308that is configured to apply text from the speech recognition module 306and/or the data 202, 213, and/or 214 to the virtual assistant/chatbotlogic 212. The potential inputs into the response engine 308 accordinglyinclude text from the speech recognition module 306 and/or text from achatbot program provided by the user interface 201 of the therapymachine 90 or the application 240 of the personal mobile communicationdevice 122. The inputs also include the prescribed therapy or program202, the treatment data 213, and/or the patient data 214.

The example adaptive interface 308 includes an input interface 310 thatis configured to receive text and/or other inputs entered into the userinterface 201 of the therapy machine 90 or the application 240 of thepersonal mobile communication device 122. The inputs may includeselection of an icon that causes the adaptive interface 308 to begin avirtual interactive session with a patient. The inputs may also includetext that is entered into a chat session via the user interface 201 ofthe therapy machine 90 or the application 240 of the personal mobilecommunication device 122. In some instances, the response engine 308launches a virtual chat session by opening a virtual chat or textmessaging session on the user interface 201 of the therapy machine 90 orthe application 240 of the personal mobile communication device 122.Text entered by a user into a field or text box is transmitted by theuser interface 201 of the therapy machine 90 or the application 240 ofthe personal mobile communication device 122 to the response engine 308via the input interface 310. In some instances, the input interface 310may include one or more application programming interfaces (“APIs”) thatconnect to the text messaging application, which enable routing ofentered text to the response engine 308. In addition to text, the inputinterface 308 may accept images, video, emojis, or selection indicationsof displayed options.

To receive the treatment data 213 from the therapy machine 90, theserver 204 includes a machine interface 312. The example memoryinterface 312 is configured to request or otherwise receive thetreatment data 213 from the therapy machine 90. In some embodiments, theadaptive interface 308 is configured to use the machine interface 312 torequest the treatment data 213 after detecting that a patient has beguna virtual interactive session. In another embodiments, the adaptiveinterface 302 may search the clinician database 206 for relevanttreatment data 213 and/or patient data 214 (and a prescribed therapy orprogram) using the machine interface 312 when the virtualassistant/chatbot logic 212 is configured to use certain medicalinformation for answering a question, determining a response action 238,or otherwise creating content for a response action 238.

FIG. 4 is a diagram of a process 400 performed by the virtualassistant/chatbot logic 212 for triaging a patient inquiry, according toan example embodiment of the present disclosure. The example process 400begins when a patient initiates a query using the application 240 on thepersonal mobile communication device 122 and/or the display interface201 of the therapy machine 90. The virtual assistant/chatbot logic 212and uses logic to select one or more follow up questions. In otherwords, the virtual assistant/chatbot logic 212 provides an interactivesession to progress through a hierarchy of questions with one or moreprompts to receive further information until a response action 238 isidentified. In some embodiments, the hierarchy ofrequests/answers/questions of the virtual assistant/chatbot logic 212may be modified based on protocols of a hospital system or clinic.

FIG. 5 is a diagram that shows an interface of the application 240provided on the personal mobile communication device 122, according toan example embodiment of the present disclosure. At Event A, theapplication 240 displays at least some treatment data 213 includingultrafiltration trends. The interface includes an icon 500 that enablesthe patient to initiate the virtual assistant/chatbot logic 212. Event Bshows the application displaying an interactive interface 502 for thevirtual assistant/chatbot logic 212. The interactive interface 502includes automated text from the virtual assistant/chatbot logic 212asking a patient for their issue or question. As shown, the patienttypes or speaks that they are running low on minicaps (i.e., a PDdisposable item). The interactive interface 502 may also display apicture of a generic virtual assistant or a picture of the patient'sclinician. The text or speech provided by the patient is processed bythe clinician server and/or the virtual assistant/chatbot logic 212, asdiscussed above.

The virtual assistant/chatbot logic 212 includes listing of possibleissues and keywords associated with the issues. The response engine 308in conjunction with the virtual assistant/chatbot logic 212 performkeyword matching to determine which issue a patient is likely referring.In the example, above, a patient indicates that help is needed with analarm, but fails to identify the type of alarm (e.g., an occlusionalarm, a dialysis fluid leakage alarm, a low container alarm, a pumpingalarm, a overfill alarm, etc.). In this instance, the virtualassistant/chatbot logic 212 specifies keywords associated with eachalarm type. Instead of asking the patient more questions, the responseengine 308 uses the treatment data 213 to determine that an occlusionalarm is active. This additional piece of information enables theresponse engine 308 and/or the virtual assistant/chatbot logic 212 todetermine that the issue relates to an occlusion alarm.

The virtual assistant/chatbot logic 212 includes a data structure ofpossible issues. Each issue has one or more keywords that are related tothe issue. The keywords are preselected based on an analysis of the data202, 213 and/or 214 and patient responses from a population of patientsrelated to the issue. For example, an issue for an occlusion alarmincludes keywords such as “alarm, alert, noise, flashing, beeping, andwarning”. The keywords may also include diagnostic identifiers generatedby the therapy machine 90 (and included in the treatment data 213)associated with an occlusion detection. These keywords may includediagnostic trouble codes, field identifiers for occlusion detection, orevent identifiers.

The virtual assistant/chatbot logic 212 is configured to compare thereceived text and data 202, 213, and/or 214 to each of the higher-orderissues. The virtual assistant/chatbot logic 212 selects an issue with agreatest matching score or probability based on the comparison with thekeywords. The virtual assistant/chatbot logic 212 may prevent aselection if a match does not exceed a match threshold, such as 60% or75%. In this instance, the virtual assistant/chatbot logic 212 includesfollow up questions to ask the patient based on which issues have thegreatest matching scores.

The virtual assistant/chatbot logic 212 may include a hierarchy ofquestions and answers for at least some of the possible issues. Theseadditional questions and answers may further refine an issue to a moreprecise issue to provide a better resolution. For example, ahigher-order issue may refer just to alarms. The lower level questionsand answers provide keywords and criteria of different types of alarms.In some instances, the answers may be determined directly from the data202, 213, and/or 214 without further input from the patient, as in theocclusion alarm example discussed above. However, if any of the lowerlevel answers cannot be determined, the virtual assistant/chatbot logic212 uses the listed questions associated with each possible answer of ahigher-level issue for selecting which questions are provided to thepatient for follow up. The hierarchy of the virtual assistant/chatbotlogic 212 provides an issue/sub-issue transversal that causes theresponse engine 308 to quickly converge upon a likely issues experiencedby the patient for determining the response action 238.

At some point in the hierarchy, answers for a sub-issue are associatedwith the response action 238. The virtual assistant/chatbot logic 212determines when there is a match or likely match above a threshold witha response action 238. Based on this match, the response engine 308transmits the response action 238 to the patient and/or an identifiedclinician. In some instances, a response action 238 may be provided forhigher-level issues without needing to progress through a hierarchy ofsub-issues. The virtual assistant/chatbot logic 212 accordingly defineshow the response engine 308 is to interact with a patient to identifywhich issue is being experienced by a patient.

As shown in FIG. 4 , there are a number of different possible responseactions 238 based on a determined criticality level. In someembodiments, the virtual assistant/chatbot logic 212 may have threelevels. In other embodiments, there may be fewer or greater levels. In athree-level configuration, a lowest level corresponds to basic patientquestions or requests that can be automatically answered without humanintervention. These includes questions/requests about a patient's guide,supply reordering, and/or general information about the therapy machine90. A medium-level corresponds to a request/patient question for aclinician to address as their time permits, thereby not interrupting theclinician's workflow. These questions or requests can relate to mild ormoderate medical issues and/or infrequent issues with the therapymachine 90. A critical-level corresponds to questions/requests that needto be answered by a clinician immediately. These response actions 238are flagged, prioritized, and escalated by the clinician server 204.These questions/requests or patient inquiries may relate to peritonitis,fluid status, and frequent or ongoing issues with the therapy machine90.

FIG. 4 also shows at least some of the prescribed therapy or programs202, treatment data 213, and/or patient data 214 that may be used by thevirtual assistant/chatbot logic 212 to more quickly converge upon theresponse action 238 or create content for the response action 238. Theprescribed therapy or programs 202 includes treatment parameters that bedefined in one or more dialysis prescriptions or programs. For PD, theprescribed therapy or programs 202 may include one or more of a totalfill volume, a number of cycles, a fill rate, a fill volume per cycle, adwell time, a drain rate, an expected ultrafiltration (“UF”) removed percycle or treatment, a dialysis fluid concentration (e.g., dextroseconcentration), or a treatment schedule. For HD, the prescribed therapyor programs 202 may specify a treatment time, a blood circulation rate,a dialysis fluid circulation rate, a dialysis fluid volume, a treatmentschedule, or a dialysis fluid concentration. For an infusion therapy,the prescribed therapy or programs 202 may include an infusion rate, avolume of fluid to be infused, a fluid type/volume, a drug or componentconcentration of the fluid, and a total infusion time. The prescribedtherapy or programs 202 may be received from the therapy machine 90and/or the clinician database 206 (as stored in a patient's EMR).

The treatment data 213 describes how a dialysis treatment was performed.As shown in FIG. 4 , the treatment data 213 may include for a PDtreatment at least one of dates/times that treatments were performed, anumber of cycles per treatment, a fill volume, a drain volume, anestimated or measured amount of UF removed, and any events that occurredduring a treatment. The events may include an alarm, an alert, a patiententry conflicting with a limit or threshold, a line occlusion, a lineleak/disconnection, pausing of a treatment, etc. In some instances, thetreatment data 213 may also include physiological data when the therapymachine 90 is connected to or includes one or more sensors, such as ablood pressure sensor or cuff, a weight scale, a heart rate sensor, anECG sensor, etc. Altogether, the treatment data 213 provides a summaryof how a dialysis treatment was performed.

The treatment data 213 may further include device information. Forinstance, the device information 508 may include a correct status of thetherapy machine 90, such as whether the machine is in a primingsequence, a cleaning/disinfection sequence, about to start a cycle of aPD treatment, progressing through a fill phase, progressing through adwell phase, progressing through a drain phase, or finished with a cycleor treatment. The device information may also include diagnosticinformation, such as faults detected in one or more pumps, valves, orother dialysis components.

The patient data 214 relates to information specific for patient thatcannot be readily determined through monitoring of the therapy machine90. The patient data 214 may include patient activity information,patient demographic information, and patient medical information. Thepatient activity information is determined through one or more questionand answer sessions with a patient. Additionally or alternatively, thepatient activity information may be determined from a patient's EMR.

In an example, a PD treatment may take three or four hours to complete.During this time, a patient is fluidly connected to the therapy machine90 during at least dialysis fluid fill and drain phases of a cycle,which can be boring for a patient. To help fill the time, the clinicianserver 204 may be configured to determine from the treatment data 213that a fill phase will occur for the next 30 minutes. Also, theclinician server 204 is configured to determine from the speechrecognition module 306 that the ambient environment is quiet. Based onthese conditions, the clinician server 204 may be configured to begin avirtual session with a patient to fill the time to acquire some patientdata 214, which may include diet information, fluid intake, medications,activity level, mental state, and sleep pattern. The clinician server204 may prompt the patient with simple questions, such as “What have youeaten today?”, “Which medications have you taken?”, “What have you donetoday?”, and “How are you feeling?” and “How did you sleep?”. Patientresponses are recorded by the clinician server 204 as the patient data214. The clinician server 204 may timestamp the patient data 214 toenable trends to be determined. In some instances, the clinician server204 may use the virtual assistant/chatbot logic 212 for asking questionsand determining if follow up questions are needed. In addition to askingquestions during a treatment, the clinician server 204 may ask questionsafter a treatment or before a treatment at times that are not likely tointerrupt a patient.

In addition to prompting the patient for patient activity information,the clinician server 204 may prompt the patient for the patientdemographic information. Alternatively, the clinician server 204 mayobtain the patient demographic information from one or more EMRs storedin the clinician database 206. As shown in FIG. 4 , the patientdemographic information may include gender, age, weight, race,ethnicity, and geographic location. The clinician server 204 may use thevirtual assistant/chatbot logic 212 to obtain the patient demographicinformation from a patient before, during, or after treatments.

The clinician server 204 may also prompt a patient for the patientmedical information using the same virtual session. Alternatively, theclinician server 204 may use the therapy machine 90 to obtain at leastsome of the patient medical information using a connected physiologicalsensor. In yet other instances, the clinician server 204 obtains thepatient medical information of the patient data 214 from one or moreEMRs. Altogether, the patient data 214 provides a summary of a health ofa patient that may include at least some subject information that isobtained through a virtual session.

As shown in FIG. 4 , the process 400 includes triaging the patientrequest into an appropriate response action 238. A first response action238 a corresponds to providing an automated response to a patient. Thefirst response action 238 a is selected for designated low-levelinquires. The responses reference certain sections of medical and/orproduct documentation and/or sections of the patient data 214 (e.g., apatient's EMR). The clinician server 204 copies the information andincludes the information in one or more response messages as theresponse action 238 a. The messages may be conveyed as a text ormultimedia message, a voice message, and/or an audiovisual message. Thefollowing questions and responses may be provided via the responseaction 238 a:

-   -   Example 1: Question can be answered by Chatbot and/or Patient        Guide        -   “How do I connect my new solution bag?”        -   Answer with Information on page 93 of a Patient Guide        -   Chatbot replies and closes the call    -   Example 2: routine but patient-specific question        -   “I'm running low on Minicaps, when is my next delivery?”        -   Something with clear yes/no that can be answered easily.        -   Chatbot answers directly—easy question for a database to            answer.

Response actions 238 b, 238 e, and 238 f of FIG. 4 corresponds tocritical-level responses. Here, the clinician server 204 determines thata patient needs to be placed in contact with a clinician, nurse, ordoctor. The clinician server 204 uses the virtual assistant/chatbotlogic 212 in conjunction with the patient responses and the data 202,213, and/or 214 to determine which practitioner is best able to handlethe response in addition to determining the criticality of the response.After identifying an individual, the clinician server 204 determinestheir phone number or virtual identifier in an electronic address bookto establish a communication session. The clinician server 204 mayinclude a communication interface 314 to establish a voice call, a videocall, a conference call, and/or a live text session. The communicationinterface 314 may transmit one or more messages to the identifiedclinical device 152 and the personal mobile communication device 122 toestablish the session via the respective response action 238 b, 238 e,or 238 f. In some embodiments, the communication interface 314 addscontent for the response action 238 for viewing on the application 242of the clinician device 152. The content may include informationprovided by the patient during the virtual session, and/or relevantportions of the data 202, 213, and/or 214. Below is an exampleinteraction.

-   -   Example 3: Urgent question, sent directly to nurse immediately        -   “My stomach hurts and my effluent is cloudy. What do I do?”        -   Contacts nurse with urgent note/escalation of message; and            tell patient to come in

In some embodiments, the clinician server 204 selects the responseaction 238 c for messages to a manufacturer of the therapy machine 90.The response action 238 c may include a text message, voicemail, email,etc. that can be addressed in time by a call center of the manufacturer.In some urgent instances, the clinician server 204 establishes a livesession, as discussed above. Below is an example interaction.

-   -   Example 4: Question can be answered by Chatbot        -   “There is something floating in my new solution bag, what            should I do?”        -   Answer with “Don't use it; I will connect you with Product            Surveillance”        -   Chatbot replies and closes the call

FIG. 4 also shows response actions 238 d where a message is provided toa clinician. In these instances, the clinician server 204 constructs anemail, text message, voice message, etc. that includes some informationdetermined from the virtual interaction with the patient and/or the data202, 213, and/or 214. Further, the clinician server 204 may prompt thepatient to leave a voicemail or other text for the clinician. In theseexamples, the clinician server 204 uses the communication interface 316to transmit the response action 238 d to an appropriate communicationaccount of the clinician. Below is an example interaction.

-   -   Example 5: Harder question to answer, leave a voicemail with        clinic that is given a prioritization score. Can't be answered        with patient guide but not urgent.        -   “I'm doing my 24 hour collection soon and I forgot how to do            it; can you help?”        -   Nurse will get a message and can call back later with            instructions

FIG. 6 is a diagram of a dashboard 600 provided by a clinicianapplication 242 for responding to the response actions 238 d, accordingto an example embodiment of the present disclosure. The dashboard 600shows a list of patients and response actions 238 d associated with eachpatient by day. The dashboard 600 is configured to enable the clinicianto select a response action 238 d. In response to a selection, thedashboard 600 of the application 242 provides an interface for aclinician to type or record a response, which is then transmitted viathe clinician server 204 to the application 240 of the personal mobilecommunication device 122.

The dashboard 600 also provides indications as to which response actions238 d have been addressed. In some embodiments, the dashboard 600changes a color of an icon or otherwise promotes a response action 238 dto gain a clinician's attention if a response is not provided within athreshold time period, such as two hours, four hours, six hours, twelvehours, 24-hours, 48-hours, etc. Further, if a response action 238 d hasnot been addressed within the threshold, the clinician server 204 mayprovide the response action 238 d to the dashboard of other clinicians.The dashboard 600 may also enable a clinician to route a response action238 a to another clinician.

III. Conclusion

It should be understood that various changes and modifications to thepresently preferred embodiments described herein will be apparent tothose skilled in the art. Such changes and modifications can be madewithout departing from the spirit and scope of the present subjectmatter and without diminishing its intended advantages. It is thereforeintended that such changes and modifications be covered by the appendedclaims.

The invention is claimed as follows:
 1. A virtual assistant/chatbotsystem to improve clinical workflows for home renal replacementtherapies, the system comprising: an interface communicatively coupledto a network, the interface configured to communicate with anapplication on user devices or an interface for medical devices; amemory device storing a patient inquiry triage data structure for avirtual assistant or chatbot, the data structure including a pluralityof potential issues related to dialysis or operation of a medicaldevice, each issue including a hierarchy of questions and possibleanswers that lead to a response action, the response action including adirect communication connection with a clinician and a communicationconnection with a voicemail system, a person-to-person chat system, oran email system; and a processor communicatively coupled to theinterface and the memory device, the processor configured to receive aninquiry message from the application on a user device or the interfaceof a medical device, provide an interactive session using the virtualassistant or chatbot to progress through the hierarchy of questions withone or more prompts to receive further information until a responseaction is identified, when the response action is related to directcommunication, determine an address or number of a clinician device andcause a communication session to be initiated between the application onthe user device or the interface of the medical device and the cliniciandevice, and when the response action is related to the voicemail system,the person-to-person chat system, or the email system, determine anaccount of a clinician and enable the patient to use the application onthe user device or the interface of the medical device to send a requestmessage for a clinician.
 2. The system of claim 1, wherein the processoris further configured to incorporate at least some of the furtherinformation from the interactive session with the request message forthe clinician.
 3. The system of claim 1, wherein the processor, thememory device, and the interface are located in a cloud-computingenvironment.
 4. The system of claim 1, wherein the inquiry message andthe further information is received as speech, and the processor isconfigured to convert the speech to text.
 5. The system of claim 1,wherein the processor is further configured to: receive a clinicianresponse message from the account of the clinician for the voicemailsystem, the person-to-person chat system, or the email system; andtransmit the clinician response message to the application on the userdevice or the interface of the medical device.
 6. The system of claim 1,wherein the response action further includes an automated responseaction, and when the response action is related to the automatedresponse action, the processor is configured to transmit informationindicative of the automated response action to the application on theuser device or the interface of the medical device.
 7. The system ofclaim 6, wherein the automated response action includes at least one ofan answer from a patient guide, an answer about an order for a medicaldevice consumable item, an answer related to an operation of the medicaldevice, or a preprogrammed answer related to general patient health ormedical conditions.
 8. The system of claim 1, wherein the responseaction further includes a medical device manufacturer response action,and when the response action is related to the medical devicemanufacturer response action, the processor is configured to determinean address or number of a manufacturer device and cause a communicationsession to be initiated between the application on the user device orthe interface of the medical device and the manufacturer device.
 9. Thesystem of claim 8, wherein the medical device manufacturer responseaction relates to at least one of reordering consumables for the medicaldevice, a technical issue with the medical device, or an operationalissue with the medical device.
 10. The system of claim 1, wherein themedical device includes at least one of a peritoneal dialysis machine, ahemodialysis machine, a continuous renal replacement therapy (“CRRT”)machine, an infusion pump, or a patient-controlled analgesia (“PCA”)machine.
 11. The system of claim 1, wherein the processor is furtherconfigured to: access at least one of treatment data from the medicaldevice or patient data related to the patient from an electronic medicalrecord after receiving the inquiry message; and use at least some of thetreatment data or the patient data as answers for progressing throughthe hierarchy of questions as part of the interactive session.
 12. Thesystem of claim 1, wherein the processor is further configured to:access at least one of treatment data from the medical device or patientdata related to the patient from an electronic medical record afterreceiving the inquiry message; and include at least some of thetreatment data or the patient data with the request message for theclinician.
 13. The system of claim 1, wherein the treatment dataincludes at least one of (i) treatment parameters for a dialysisprescription, (ii) results from performing one or more dialysistreatments, (iii) diagnostic information related to the medical device,or (iv) a current status of the medical device, and wherein the patientdata includes at least one of electronic medical record information,laboratory results, electronic clinician notes, previous medicaldiagnoses, patient physiological data, or patient demographic data. 14.The system of claim 1, wherein a hierarchy of the patient inquiry triagedata structure is configured to be modified based on protocols of ahospital system or clinic.
 15. A virtual assistant/chatbot method toimprove clinical workflows for home renal replacement therapies, themethod comprising: receiving, in a processor, an inquiry message from anapplication on a user device or an interface of a medical device;providing, via the processor, an interactive session using a virtualassistant or chatbot to progress through a hierarchy of questions withone or more prompts to receive further information until a responseaction is identified, instructions for the virtual assistant or chatbotbeing stored in a memory device that also stores a patient inquirytriage data structure for the virtual assistant or chatbot, the datastructure including a plurality of potential issues related to dialysisor operation of a medical device, each issue including the hierarchy ofquestions and possible answers that lead to a response action, theresponse action including a direct communication connection with aclinician and a communication connection with a voicemail system, aperson-to-person chat system, or an email system; when the responseaction is related to direct communication, determining, via theprocessor, an address or number of a clinician device and causing acommunication session to be initiated between the application on theuser device or the interface of the medical device and the cliniciandevice; and when the response action is related to the voicemail system,the person-to-person chat system, or the email system, determining anaccount of a clinician and enabling the patient to use the applicationon the user device or the interface of the medical device to send arequest message for a clinician.
 16. The method of claim 15, furthercomprising incorporating, via the processor, at least some of thefurther information from the interactive session with the requestmessage for the clinician.
 17. The method of claim 15, wherein theinquiry message and the further information is received as speech, andthe method includes converting the speech to text.
 18. The method ofclaim 15, further comprising: receiving, in the processor, a clinicianresponse message from the account of the clinician for the voicemailsystem, the person-to-person chat system, or the email system; andtransmitting, via the processor, the clinician response message to theapplication on the user device or the interface of the medical device.19. The method of claim 15, wherein the response action further includesan automated response action, and when the response action is related tothe automated response action, the method further includes transmittinginformation indicative of the automated response action to theapplication on the user device or the interface of the medical device.20. The method of claim 19, wherein the automated response actionincludes at least one of an answer from a patient guide, an answer aboutan order for a medical device consumable item, an answer related to anoperation of the medical device, or a preprogrammed answer related togeneral patient health or medical conditions.
 21. The method of claim15, further comprising: accessing, via the processor, at least one oftreatment data from the medical device, a prescribed therapy or program,or patient data related to the patient from an electronic medical recordafter receiving the inquiry message; and including, via the processor,at least some of the treatment data, the prescribed therapy or program,or the patient data with the request message for the clinician, whereinthe prescribed therapy or program includes treatment parameters for adialysis prescription, the treatment data includes at least one of (i)results from performing one or more dialysis treatments, (ii) diagnosticinformation related to the medical device, or (iii) a current status ofthe medical device, and wherein the patient data includes at least oneof electronic medical record information, laboratory results, electronicclinician notes, previous medical diagnoses, patient physiological data,or patient demographic data.